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Hydatid disease of proximal femur treated using a mega prosthesis: A case report
CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 68 (2020) 67–73
Contents lists available at ScienceDirect
International Journal of Surgery Case Reports journal homepage: www.casereports.com
Hydatid disease of proximal femur treated using a mega prosthesis: A case report Achraf Oueslati ∗ , Khalil Amri, Mohamed Ali Chefi, Youssef Mallat, Tallel Znagui, Lotfi Nouisri Department of Orthopaedic Surgery and Traumatology, Military Hospital of Instruction of Tunis, Tunisia
a r t i c l e
i n f o
Article history: Received 21 November 2019 Received in revised form 24 January 2020 Accepted 1 February 2020 Available online 6 February 2020 Keywords: Bone hydatidosis Femur Mega prosthesis
a b s t r a c t INTRODUCTION: Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage. PRESENTATION OF CASE: We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up. DISCUSSION: Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage. CONCLUSION: Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations. © 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
1. Introduction Osseous hydatid disease is an involvement of the bone by an anthropozoonosis, caused by the larval form of the tapeworm Echinococcus granulosus [1]. Even in endemic areas, bone hydatidosis contributing only 0.5–2.5% of all hydatid cysts [2,3]. It is challenging to manage because the symptoms are generally late, and the radiological images are not specific. As a result, the diagnosis is often made only at the late stage of extension of the parasitic osteitis, which makes the treatment difficult [4], and the prognosis is so severe that this condition has been called “white cancer” [5]. We report here a case of a misdiagnosed hydatidosis of the upper extremity of the femur. Evolution was severe with a rapid
∗ Corresponding author. E-mail addresses: [email protected] (A. Oueslati), [email protected] (K. Amri), mohamedalichefi@gmail.com (M.A. Chefi), [email protected] (Y. Mallat), Z [email protected] (T. Znagui), [email protected] (L. Nouisri).
widespread bony disruption. Treatment consisted of extensive resection and reconstruction by a mega prosthesis. This work has been reported in line with the SCARE 2018 criteria [6] 2. Case report We report a case of A 29-year-old woman living in a rural area and working as a farmer, with no significant pathological history. She was presented to our hospital for right hip pain. A physical examination revealed a right hip pain at mobilisation, with a normal range of motion. Plain X-rays and a Computed tomography of the right hip showed a lytic bone lesion well limited at the level of the upper metaphysis of the right femur without periosteal reaction or a weakening of the cortex (Fig. 1). The diagnosis of the unicameral bone cyst was retained based on the radiological aspect. A gamma nail osteosynthesis was performed to prevent the risk of fractures. The surgery had an immediate simple operative sequence, but the patient didn’t present to the late follow-up. Five years later, she was admitted to our hospital for a recurrence of the right hip pain and tumefaction, which is progressively
https://doi.org/10.1016/j.ijscr.2020.02.002 2210-2612/© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
CASE REPORT – OPEN ACCESS 68
A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Fig. 1. CT image of a lytic bone lesion of the upper femoral metaphysis.
getting worse and restricting the daily activity. The physical examination revealed a tumefaction at the level of the femoral greater trochanter. The right hip joint was painful and stiff. The scar was good, and there were no signs of inflammation of the superficial skin. Conventional radiology showed extensive lysis of the right trochanteric region and the femoral neck. And the loosening of osteosynthesis material (Fig. 2). Computed tomography (CT) revealed a bone loss in the trochanteric region, cystic lesion of the peri-trochanteric soft tissue, calcified in some places and with an outline delineating it from the surrounding muscles (Fig. 3). Findings were compatible with a hydatid cyst. So, we decided to remove the osteosynthesis material (Fig. 4) and make a bone biopsy. The biopsy brought membranous elements of white-pearly colour, and microscopic histopathological examinations confirmed the diagnosis of a hydatid cyst.
Magnetic resonance imaging (MRI) was performed to evaluate the local extension. It showed multiple cystic lesions. These cystic lesions were extending from the upper 1/3 of the femoral diaphysis to the epiphysis, and it doesn’t cross the joint space. In the soft parts, the lesions spread to the minimus and medius gluteus muscles (Fig. 5). Careful clinical examination, chest X-rays and an abdominal ultrasound scan revealed no other lesions. Under general anaesthesia, a senior surgeon carefully isolated the entire cyst from the surrounding muscles and excised it with 12 cm of the proximal femur. The excision was made, leaving a wide chirurgical margin, and a reconstruction by a mega prosthesis of the right hip was performed (Fig. 6). Postoperative recovery was remarkably uneventful, and she was able to walk with crutches. Three months later, she was walking without help. Her only problem was a 2 cm limb shortening well correct by an orthopaedic sole. she was satisfied and resumed
Fig. 2. X-ray images showing the extensive lysis of the right trochanteric region and the femoral neck..
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
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Fig. 3. CT images showing a bone loss in the trochanteric region, and cystic lesion of the peri-trochanteric soft tissue..
normal daily activity without discomfort. And, there had been no recurrence three years after the cyst was removed (Fig. 7).
3. Discussion Hydatid disease is a parasitic disease caused by the development in humans of the larval form of a tapeworm called Echinococcus Granulosus. Contamination occurs through the accidental ingestion of Echinococcus Granulosus eggs from contaminated food. Its preferential localisation in the lung and the liver, Bone hydatidosis is rare; it accounts for only 0.5–2.5% of all locations [2,3]. Bone localisation has a slow and progressive evolution. But it has a diffuse and infiltrative character. It gradually invades the whole bone and adjacent soft parts, which makes it often late diagnosed and more complicated to manage. The clinical signs are not specific, dominated by pain, swelling, and fractures, which is a significant mode of revelation. Conventional radiology shows a cystic or irregular destruction of bone with a “honeycomb” appearance without periosteal reaction. These characteristics often cause misdiagnoses such as bone cyst and giant cell tumour of bone [7,8]. CT and MRI findings show the location, size, and appearance of the cyst. However, MRI is more reliable than CT because it shows not only the peripheral rim of the cyst and its multilocular character, but it also has a particular value in revealing the relationship of the lesion to the surrounding soft tissue [9].
In some situation, especially at an early stage, Clinical and radiological signs could be non-specific, which can lead to misdiagnosis. Like in our case, it was diagnosed as a bone cyst. This situation has serious consequences. However, we could avoid this situation if we focus on some features like the rural origin and professional exposition of the patient, and pushing further the anamnesis. At least we would have thought about the bone hydatid cyst and investigate further. We could practice immunodiagnostics tests such as Enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence test or other tests. These tests are easy to perform and have a great sensibility and specificity [10]. The healing treatment of hydatid osteopathy requires surgery. Surgery could be conservative with curettage and aspiration of the bone cyst. But, the ideal surgery, when it is possible would be radical and perform an extensive oncological resection [11] of the cyst and surrounding bone and replacement of bone defects with bone grafts or a prosthesis. This carcinological resection avoids secondary infection, and prevent local recurrence that occurs in conservative treatment and which rate of 50% in some cases [8,12]. In our case, the massive reconstruction prosthesis allowed us to be wide at resection, without compromising the functional prognosis and quality of life of our patient. Regarding chemotherapy, mainly albendazole, its effectiveness remains controversial, and there is no consensus on the dose and duration of treatment [13,14]. It was not adopted in our case.
CASE REPORT – OPEN ACCESS 70
A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Fig. 4. X-ray images after removing the osteosynthesis material.
Fig. 5. MRI images to evaluate the local extension of cystic lesions.
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Fig. 6. Postoperative X-ray images.
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Fig. 7. Three years postoperative X-ray images.
4. Conclusion Bone hydatidosis is a rare disease. Radiological aspect can simulate other pathologies like a bone cyst in our case, which leave to a misdiagnosis and a severe prognosis. In these situations, the anamnesis has a primordial place because some information, such as the patient’s living area or his professional exposure, can guide the diagnosis and investigations.
Funding There are no sources of funding for our research. Ethical approval We declare that ethical approval has been given. Consent A written informed consent was obtained from the patient.
Declaration of Competing Interest There are no conflicts of interest.
Author contribution Achraf Oueslati: Original draft writing.
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Khalil Amri: Data analysis. Mohamed Ali Chefi: Data collection. Youssef Mallat: Paper editing. Tallel Znagui: Supervision. Lotfi Nouisrif: Paper validation. Guarantor Oueslati Achraf. Provenance and peer review Not commissioned, externally peer-reviewed. References [1] J.F. Briant, P. Richez, E. Belliol, D. Barea, A. Raillat, P. Salamand, G.E. Gueguen, C. Arteaga, G. Clavel, Mise au point atteintes osteo-articulaires d’origine parasitaire: l’echinococcose osseuse, J. Radiol. 79 (1998) 1351–1357. [2] T. El Madhi, A. Ameur, M. El Ounani, J. Medaghri, M. Boumdin, M. Manouar, Hydatidose osseuse: a propos de dix observations, Maghreb Médical. (1996) 16–20. [3] M. Zlitni, M. Kooli, K. Ezzaouia, H. Lebib, M. Mestiri, Manifestations Osseuses Des Parasitoses. Encycl Méd Chir, Appareil Locomoteur, Elsevier, Paris, 1996. [4] J.P. Franceschi, G. Curvale, P. Noca, H. Roux, Kyste hydatique du bassin: à propos d’un cas suivi sur 8 ans, Revue Du Rhumatisme et Des Maladies Ostéo-Articulaires 58 (1991) 211–213.
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[5] F. DÉVÉ, Hydatid Disease of the Bones, Hydatid Disease of the Bones, 1948. [6] R.A. Agha, M.R. Borrelli, R. Farwana, K. Koshy, A.J. Fowler, D.P. Orgill, H. Zhu, A. Alsawadi, A. Noureldin, A. Rao, The SCARE 2018 statement: updating consensus Surgical CAse REport (SCARE) guidelines, Int. J. Surg. 60 (2018) 132–136. [7] E. Brunetti, P. Kern, D.A. Vuitton, Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans, Acta Trop. 114 (2010) 1–16. [8] J. Csotye, K. Sisák, L. Bardócz, K. Tóth, Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis-case report, BMC Infect. Dis. 11 (2011) 103. [9] F. García-Alvarez, J. Torcal, J.C. Salinas, A. Navarro, I. García-Alvarez, M. Navarro-Zorraquino, R. Sousa, E. Tejero, R. Lozano, Musculoskeletal hydatid disease: a report of 13 cases, Acta Orthop. Scand. 73 (2002) 227–231. [10] G. Özkoc¸, S. Akpınar, M.A. Hersekli, M. Özalay, R. Tando˘gan, Primary hydatid disease of the quadriceps muscle: a rare localization, Arch. Orthop. Trauma Surg. 123 (2003) 314–316. [11] W. Mnaymneh, V. Yacoubian, K. Bikhazi, Hydatidosis of the pelvic girdle–treatment by partial pelvectomy, A case report, JBJS. 59 (1977) 538–540. [12] H. Loudiye, S. Aktaou, H. Hassikou, A. El Bardouni, M. El Manouar, M. Fizazi, A. Tazi, N. Hajjaj-Hassouni, Hydatid disease of bone: review of 11 cases, Joint Bone Spine 70 (2003) 352–355. [13] S. Baklouti, M.H. Elleuch, H. Fourati, M. Guermazi, R. Jlidi, S. Sellami, Kyste hydatique osseux du fémur: à propos d’un cas d’aspect radiologique trompeur, La Semaine Des Hôpitaux de Paris 71 (1995) 102–105. [14] N. Bergaoui, M. Ben Hammouda, M. Touzi, B. Khalfallah, M. Chaabouni, A. Gannouni, M. Elmay, Hydatidose à localisation costale et extradurale dorsale, Rhumatologie. 48 (1996) 207–211.
Open Access This article is published Open Access at sciencedirect.com. It is distributed under the IJSCR Supplemental terms and conditions, which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Contents lists available at ScienceDirect
International Journal of Surgery Case Reports journal homepage: www.casereports.com
Hydatid disease of proximal femur treated using a mega prosthesis: A case report Achraf Oueslati ∗ , Khalil Amri, Mohamed Ali Chefi, Youssef Mallat, Tallel Znagui, Lotfi Nouisri Department of Orthopaedic Surgery and Traumatology, Military Hospital of Instruction of Tunis, Tunisia
a r t i c l e
i n f o
Article history: Received 21 November 2019 Received in revised form 24 January 2020 Accepted 1 February 2020 Available online 6 February 2020 Keywords: Bone hydatidosis Femur Mega prosthesis
a b s t r a c t INTRODUCTION: Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage. PRESENTATION OF CASE: We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up. DISCUSSION: Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage. CONCLUSION: Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations. © 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
1. Introduction Osseous hydatid disease is an involvement of the bone by an anthropozoonosis, caused by the larval form of the tapeworm Echinococcus granulosus [1]. Even in endemic areas, bone hydatidosis contributing only 0.5–2.5% of all hydatid cysts [2,3]. It is challenging to manage because the symptoms are generally late, and the radiological images are not specific. As a result, the diagnosis is often made only at the late stage of extension of the parasitic osteitis, which makes the treatment difficult [4], and the prognosis is so severe that this condition has been called “white cancer” [5]. We report here a case of a misdiagnosed hydatidosis of the upper extremity of the femur. Evolution was severe with a rapid
∗ Corresponding author. E-mail addresses: [email protected] (A. Oueslati), [email protected] (K. Amri), mohamedalichefi@gmail.com (M.A. Chefi), [email protected] (Y. Mallat), Z [email protected] (T. Znagui), [email protected] (L. Nouisri).
widespread bony disruption. Treatment consisted of extensive resection and reconstruction by a mega prosthesis. This work has been reported in line with the SCARE 2018 criteria [6] 2. Case report We report a case of A 29-year-old woman living in a rural area and working as a farmer, with no significant pathological history. She was presented to our hospital for right hip pain. A physical examination revealed a right hip pain at mobilisation, with a normal range of motion. Plain X-rays and a Computed tomography of the right hip showed a lytic bone lesion well limited at the level of the upper metaphysis of the right femur without periosteal reaction or a weakening of the cortex (Fig. 1). The diagnosis of the unicameral bone cyst was retained based on the radiological aspect. A gamma nail osteosynthesis was performed to prevent the risk of fractures. The surgery had an immediate simple operative sequence, but the patient didn’t present to the late follow-up. Five years later, she was admitted to our hospital for a recurrence of the right hip pain and tumefaction, which is progressively
https://doi.org/10.1016/j.ijscr.2020.02.002 2210-2612/© 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
CASE REPORT – OPEN ACCESS 68
A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Fig. 1. CT image of a lytic bone lesion of the upper femoral metaphysis.
getting worse and restricting the daily activity. The physical examination revealed a tumefaction at the level of the femoral greater trochanter. The right hip joint was painful and stiff. The scar was good, and there were no signs of inflammation of the superficial skin. Conventional radiology showed extensive lysis of the right trochanteric region and the femoral neck. And the loosening of osteosynthesis material (Fig. 2). Computed tomography (CT) revealed a bone loss in the trochanteric region, cystic lesion of the peri-trochanteric soft tissue, calcified in some places and with an outline delineating it from the surrounding muscles (Fig. 3). Findings were compatible with a hydatid cyst. So, we decided to remove the osteosynthesis material (Fig. 4) and make a bone biopsy. The biopsy brought membranous elements of white-pearly colour, and microscopic histopathological examinations confirmed the diagnosis of a hydatid cyst.
Magnetic resonance imaging (MRI) was performed to evaluate the local extension. It showed multiple cystic lesions. These cystic lesions were extending from the upper 1/3 of the femoral diaphysis to the epiphysis, and it doesn’t cross the joint space. In the soft parts, the lesions spread to the minimus and medius gluteus muscles (Fig. 5). Careful clinical examination, chest X-rays and an abdominal ultrasound scan revealed no other lesions. Under general anaesthesia, a senior surgeon carefully isolated the entire cyst from the surrounding muscles and excised it with 12 cm of the proximal femur. The excision was made, leaving a wide chirurgical margin, and a reconstruction by a mega prosthesis of the right hip was performed (Fig. 6). Postoperative recovery was remarkably uneventful, and she was able to walk with crutches. Three months later, she was walking without help. Her only problem was a 2 cm limb shortening well correct by an orthopaedic sole. she was satisfied and resumed
Fig. 2. X-ray images showing the extensive lysis of the right trochanteric region and the femoral neck..
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
69
Fig. 3. CT images showing a bone loss in the trochanteric region, and cystic lesion of the peri-trochanteric soft tissue..
normal daily activity without discomfort. And, there had been no recurrence three years after the cyst was removed (Fig. 7).
3. Discussion Hydatid disease is a parasitic disease caused by the development in humans of the larval form of a tapeworm called Echinococcus Granulosus. Contamination occurs through the accidental ingestion of Echinococcus Granulosus eggs from contaminated food. Its preferential localisation in the lung and the liver, Bone hydatidosis is rare; it accounts for only 0.5–2.5% of all locations [2,3]. Bone localisation has a slow and progressive evolution. But it has a diffuse and infiltrative character. It gradually invades the whole bone and adjacent soft parts, which makes it often late diagnosed and more complicated to manage. The clinical signs are not specific, dominated by pain, swelling, and fractures, which is a significant mode of revelation. Conventional radiology shows a cystic or irregular destruction of bone with a “honeycomb” appearance without periosteal reaction. These characteristics often cause misdiagnoses such as bone cyst and giant cell tumour of bone [7,8]. CT and MRI findings show the location, size, and appearance of the cyst. However, MRI is more reliable than CT because it shows not only the peripheral rim of the cyst and its multilocular character, but it also has a particular value in revealing the relationship of the lesion to the surrounding soft tissue [9].
In some situation, especially at an early stage, Clinical and radiological signs could be non-specific, which can lead to misdiagnosis. Like in our case, it was diagnosed as a bone cyst. This situation has serious consequences. However, we could avoid this situation if we focus on some features like the rural origin and professional exposition of the patient, and pushing further the anamnesis. At least we would have thought about the bone hydatid cyst and investigate further. We could practice immunodiagnostics tests such as Enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence test or other tests. These tests are easy to perform and have a great sensibility and specificity [10]. The healing treatment of hydatid osteopathy requires surgery. Surgery could be conservative with curettage and aspiration of the bone cyst. But, the ideal surgery, when it is possible would be radical and perform an extensive oncological resection [11] of the cyst and surrounding bone and replacement of bone defects with bone grafts or a prosthesis. This carcinological resection avoids secondary infection, and prevent local recurrence that occurs in conservative treatment and which rate of 50% in some cases [8,12]. In our case, the massive reconstruction prosthesis allowed us to be wide at resection, without compromising the functional prognosis and quality of life of our patient. Regarding chemotherapy, mainly albendazole, its effectiveness remains controversial, and there is no consensus on the dose and duration of treatment [13,14]. It was not adopted in our case.
CASE REPORT – OPEN ACCESS 70
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Fig. 4. X-ray images after removing the osteosynthesis material.
Fig. 5. MRI images to evaluate the local extension of cystic lesions.
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Fig. 6. Postoperative X-ray images.
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Fig. 7. Three years postoperative X-ray images.
4. Conclusion Bone hydatidosis is a rare disease. Radiological aspect can simulate other pathologies like a bone cyst in our case, which leave to a misdiagnosis and a severe prognosis. In these situations, the anamnesis has a primordial place because some information, such as the patient’s living area or his professional exposure, can guide the diagnosis and investigations.
Funding There are no sources of funding for our research. Ethical approval We declare that ethical approval has been given. Consent A written informed consent was obtained from the patient.
Declaration of Competing Interest There are no conflicts of interest.
Author contribution Achraf Oueslati: Original draft writing.
CASE REPORT – OPEN ACCESS A. Oueslati et al. / International Journal of Surgery Case Reports 68 (2020) 67–73
Khalil Amri: Data analysis. Mohamed Ali Chefi: Data collection. Youssef Mallat: Paper editing. Tallel Znagui: Supervision. Lotfi Nouisrif: Paper validation. Guarantor Oueslati Achraf. Provenance and peer review Not commissioned, externally peer-reviewed. References [1] J.F. Briant, P. Richez, E. Belliol, D. Barea, A. Raillat, P. Salamand, G.E. Gueguen, C. Arteaga, G. Clavel, Mise au point atteintes osteo-articulaires d’origine parasitaire: l’echinococcose osseuse, J. Radiol. 79 (1998) 1351–1357. [2] T. El Madhi, A. Ameur, M. El Ounani, J. Medaghri, M. Boumdin, M. Manouar, Hydatidose osseuse: a propos de dix observations, Maghreb Médical. (1996) 16–20. [3] M. Zlitni, M. Kooli, K. Ezzaouia, H. Lebib, M. Mestiri, Manifestations Osseuses Des Parasitoses. Encycl Méd Chir, Appareil Locomoteur, Elsevier, Paris, 1996. [4] J.P. Franceschi, G. Curvale, P. Noca, H. Roux, Kyste hydatique du bassin: à propos d’un cas suivi sur 8 ans, Revue Du Rhumatisme et Des Maladies Ostéo-Articulaires 58 (1991) 211–213.
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[5] F. DÉVÉ, Hydatid Disease of the Bones, Hydatid Disease of the Bones, 1948. [6] R.A. Agha, M.R. Borrelli, R. Farwana, K. Koshy, A.J. Fowler, D.P. Orgill, H. Zhu, A. Alsawadi, A. Noureldin, A. Rao, The SCARE 2018 statement: updating consensus Surgical CAse REport (SCARE) guidelines, Int. J. Surg. 60 (2018) 132–136. [7] E. Brunetti, P. Kern, D.A. Vuitton, Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans, Acta Trop. 114 (2010) 1–16. [8] J. Csotye, K. Sisák, L. Bardócz, K. Tóth, Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis-case report, BMC Infect. Dis. 11 (2011) 103. [9] F. García-Alvarez, J. Torcal, J.C. Salinas, A. Navarro, I. García-Alvarez, M. Navarro-Zorraquino, R. Sousa, E. Tejero, R. Lozano, Musculoskeletal hydatid disease: a report of 13 cases, Acta Orthop. Scand. 73 (2002) 227–231. [10] G. Özkoc¸, S. Akpınar, M.A. Hersekli, M. Özalay, R. Tando˘gan, Primary hydatid disease of the quadriceps muscle: a rare localization, Arch. Orthop. Trauma Surg. 123 (2003) 314–316. [11] W. Mnaymneh, V. Yacoubian, K. Bikhazi, Hydatidosis of the pelvic girdle–treatment by partial pelvectomy, A case report, JBJS. 59 (1977) 538–540. [12] H. Loudiye, S. Aktaou, H. Hassikou, A. El Bardouni, M. El Manouar, M. Fizazi, A. Tazi, N. Hajjaj-Hassouni, Hydatid disease of bone: review of 11 cases, Joint Bone Spine 70 (2003) 352–355. [13] S. Baklouti, M.H. Elleuch, H. Fourati, M. Guermazi, R. Jlidi, S. Sellami, Kyste hydatique osseux du fémur: à propos d’un cas d’aspect radiologique trompeur, La Semaine Des Hôpitaux de Paris 71 (1995) 102–105. [14] N. Bergaoui, M. Ben Hammouda, M. Touzi, B. Khalfallah, M. Chaabouni, A. Gannouni, M. Elmay, Hydatidose à localisation costale et extradurale dorsale, Rhumatologie. 48 (1996) 207–211.
Open Access This article is published Open Access at sciencedirect.com. It is distributed under the IJSCR Supplemental terms and conditions, which permits unrestricted non commercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.